The Lancet commissions challenging in poor countries, which are constrained by severely scarce resources. Many countries are attempting to extend essenti service through the deployment of basic health workers, even as millions of people resort to providers without credentials, both traditional and modern 42 In an effort to achieve health goals, many poor countries are channelling external donor funding towards implementation of disease-targeted initiatives. Consequently, in many countries, po professional education is absent from the policy agenda and is overtaken by emergency or urgent action projects and is regarded as too costly, irrelevant, or long term. igure 2: Emerging challenges to health systems A renaissance to a new professionalism--patient centred and team-based-has been much discussed. AL In many countries, professionals are encountering more but it has lacked the leadership, incentives, and power to socially diverse patients with chronic conditions, who are deliver on its promise. Some attempts to redefine the more proactive in their health-seeking behaviour. -3 future roles and responsibilities of health professionals Patient management requires coordinated care across have floundered amid the rigid so-called tribalism that time and space, demanding unprecedented teamwork. afflicts them. Advocacy for specific practitioner groups has Professionals have to integrate the explosive growth of been strong, but without an overall strategy for the broader knowledge and technologies while grappling with health professional community to work together to meet expanding functions--super-specialisation, prevention, individual and population health needs. Several and complex care management in many sites, including meaning recent efforts have attempted to address different types of facilities alongside home-based and fractures, but they have fallen short. community-based care(figure 2). -12 Consequently, a slow-burning crisis is emerging in Fresh opportunities the mismatch of professional competencies to patient Opportunities are opening for a new round of reforms to and population priorities because of fragmentary, craft professional education for the 21st century, spurred outdated, and static curricula producing ill-equipped by mutual leaming due to health interdependence, changes graduates from underfinanced institutions. -1 5-20 In in educational pedagogy, the public prominence of health almost all countries. the education of health and the growing recognition of the imperative for change fessionals has failed to overcome dysfunctional and Paradoxically, despite glaring disparities, interdependence inequitable health systems because of curricula in health is growing and the opportunities for mutual rigidities, professional silos, static pedagogy (ie, the learning and shared progress have greatly expanded. science of teaching), insufficient adaptation to local Global movements of people, pathogens, technologies contexts, and commercialism in the professions. financing, information, and knowledge underlie the Breakdown is especially noteworthy within primary international transfer of health risks and opportunities care, in both poor and rich countries. The failings are and flows across national borders are accelerating. Weare systemic--professionals are unable to keep pace, increasingly interdependent in terms of key health becoming mere technology managers, and exacerbating resources, especially skilled workers. 2 protracted difficulties such as a reluctance to serve Alongside the rapid pace of change in health, there is a marginalised rural communities. 323 Professionals are parallel revolution in education. The explosive increase falling short on appropriate competencies for effective not only in total volume of information, but also in ease teamwork, and they are not exercising effective of access to it, means that the role of universities and leadership to transform health systems. other educational institutions needs to be rethought. Poor and rich countries both have workforce shortages, Learning, of course, has always been experienced outside skill-mix imbalances, and maldistribution of profess. formal instruction through all types of interactions, but ionals 7-In neither rich nor poor countries is professional the informational content and learning potential are education generating high value for money. Difficult to today without precedent. In this rapidly evolving context, design and slow to implement, educational reforms in rich universities and educational institutions are broadenin competencies attempting to develop professional their traditional role as places where people go to obtain countries e responsive to changing health information(eg, by consulting books in libraries or needs, overcome professional silos through inter- listening to expert faculty members) to incorporate novel rofessional education, harness information technology forms of learning that transcend the confines of the (IT-empowered learning, enhance cognitive skills for class lext generation of learners needs the critical inquiry, and strengthen professional identity and capacity to discriminate vast amounts of information values for health leadership. Reforms are especially and extract and synthesise knowledge that is necessary www.thelancet.comThe Lancet Commissions 8 www.thelancet.com In many countries, professionals are encountering more socially diverse patients with chronic conditions, who are more proactive in their health-seeking behaviour.28–31 Patient management requires coordinated care across time and space, demanding unprecedented teamwork.5–11 Professionals have to integrate the explosive growth of knowledge and technologies while grappling with expanding functions—super-specialisation, prevention, and complex care management in many sites, including different types of facilities alongside home-based and community-based care (figure 2).7–12 Consequently, a slow-burning crisis is emerging in the mismatch of professional competencies to patient and population priorities because of fragmentary, outdated, and static curricula producing ill-equipped graduates from underfinanced institutions.5–12,18–20 In almost all countries, the education of health pro￾fessionals has failed to overcome dysfunctional and inequitable health systems because of curricula rigidities, professional silos, static pedagogy (ie, the science of teaching), insufficient adaptation to local contexts, and commercialism in the professions. Breakdown is especially noteworthy within primary care, in both poor and rich countries. The failings are systemic—professionals are unable to keep pace, becoming mere technology managers, and exacerbating protracted difficulties such as a reluctance to serve marginalised rural communities.32,33 Professionals are falling short on appropriate competencies for effective teamwork, and they are not exercising effective leadership to transform health systems. Poor and rich countries both have workforce shortages, skill-mix imbalances, and maldistribution of profess￾ionals.7,32–35 In neither rich nor poor countries is professional education generating high value for money. Difficult to design and slow to implement, educational reforms in rich countries are attempting to develop professional competencies that are responsive to changing health needs, overcome professional silos through inter￾professional education, harness information technology (IT)-empowered learning, enhance cognitive skills for critical inquiry, and strengthen professional identity and values for health leadership.36–40 Reforms are especially challenging in poor countries, which are constrained by severely scarce resources.38,40,41 Many countries are attempting to extend essential services through the deployment of basic health workers, even as millions of people resort to providers without credentials, both traditional and modern.42 In an effort to achieve health goals, many poor countries are channelling external donor funding towards implementation of disease-targeted initiatives. Consequently, in many countries, postsecondary professional education is absent from the policy agenda and is overtaken by emergency or urgent action projects and is regarded as too costly, irrelevant, or long term. A renaissance to a new professionalism—patient￾centred and team-based—has been much discussed,37,43–47 but it has lacked the leadership, incentives, and power to deliver on its promise. Some attempts to redefine the future roles and responsibilities of health professionals have floundered amid the rigid so-called tribalism that afflicts them. Advocacy for specific practitioner groups has been strong, but without an overall strategy for the broader health professional community to work together to meet individual and population health needs. Several well meaning recent efforts have attempted to address these fractures, but they have fallen short. Fresh opportunities Opportunities are opening for a new round of reforms to craft professional education for the 21st century, spurred by mutual learning due to health interdependence, changes in educational pedagogy, the public prominence of health, and the growing recognition of the imperative for change. Paradoxically, despite glaring disparities, interdependence in health is growing and the opportunities for mutual learning and shared progress have greatly expanded.1,24 Global movements of people, pathogens, technologies, financing, information, and knowledge underlie the international transfer of health risks and opportunities, and flows across national borders are accelerating.48 We are increasingly interdependent in terms of key health resources, especially skilled workers.24 Alongside the rapid pace of change in health, there is a parallel revolution in education. The explosive increase not only in total volume of information, but also in ease of access to it, means that the role of universities and other educational institutions needs to be rethought.49 Learning, of course, has always been experienced outside formal instruction through all types of interactions, but the informational content and learning potential are today without precedent. In this rapidly evolving context, universities and educational institutions are broadening their traditional role as places where people go to obtain information (eg, by consulting books in libraries or listening to expert faculty members) to incorporate novel forms of learning that transcend the confines of the classroom. The next generation of learners needs the capacity to discriminate vast amounts of information and extract and synthesise knowledge that is necessary Figure 2: Emerging challenges to health systems Health system Technological innovation Population demands Epidemiological and demographic transitions Professional differentiation